Provider Demographics
NPI:1790976165
Name:BELL-GASH, CASSANDRA
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:
Last Name:BELL-GASH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 W STAGECOACH TRL
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:NC
Mailing Address - Zip Code:28090-9058
Mailing Address - Country:US
Mailing Address - Phone:704-300-4273
Mailing Address - Fax:
Practice Address - Street 1:2025 EBENEZER RD STE J4
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1079
Practice Address - Country:US
Practice Address - Phone:704-300-4273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11587101YM0800X, 101YP2500X
SC7155101YM0800X, 101YP2500X
251S00000X
7155251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251S00000XAgenciesCommunity/Behavioral Health